Physician Scientist Career

[NoSleepNoProblm]

Hello everyone!

I am a pre-medical student considering pursuing an MD/PhD degree. My original goal was to become an MD and specialize in Immunology, but after being exposed to research, I find that this something I both enjoy doing and hope would enhance my career as a clinician. However, after learning more about the physician-science training program and the careers for physician-scientists, I have several questions:

1. I have read that most MD-PhDs spend most of their time doing research. Is this because research is essentially an "all or nothing" endeavor? That is, if I wanted to do research at all, would it require me to adhere to the common 80/20 research/clinical ratio that I hear is very common?

2. I am aware a person with "just" an MD degree can do research. Do MDs that pursue research follow as similar path as MD/PhDs? Is their research/clinical time split any different?

3. I have heard of several alternative paths to becoming a physician-scientist and gaining research experience, such as combined MD/MS degrees, research residencies, NIH fellowships and the research provided during specialty fellowship training. Do these routes provide sufficient research experience? And are they advisable, considering (for some options) the length may be the same are pursuing the MD/PhD program, but now with medical school debt?

4. Where do physician-scientists work? The two options I almost exclusively hear are either the academic route at a university or the industrial route at a pharmaceutical company. Is private practice an option? And if one were employed by a university, would you have an opportunity to see patients, or are your hours dictated by the university?

As you can see, I really desire to have a 50/50 split between research and clinical, but I'm not quite sure this is likely, or even possible. I do have a strong interest in translational research, and am currently working on a biochemistry project right now which I am passionate about and which relates directly to medicine. However, if I had to choose one or the other, I would lean slightly towards clinical.

Any advice anyone could give would be VERY much appreciated!

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[Lil Mick]

Hello everyone!

I am a pre-medical student considering pursuing an MD/PhD degree. My original goal was to become an MD and specialize in Immunology, but after being exposed to research, I find that this something I both enjoy doing and hope would enhance my career as a clinician. However, after learning more about the physician-science training program and the careers for physician-scientists, I have several questions:

1. I have read that most MD-PhDs spend most of their time doing research. Is this because research is essentially an "all or nothing" endeavor? That is, if I wanted to do research at all, would it require me to adhere to the common 80/20 research/clinical ratio that I hear is very common?

2. I am aware a person with "just" an MD degree can do research. Do MDs that pursue research follow as similar path as MD/PhDs? Is their research/clinical time split any different?

3. I have heard of several alternative paths to becoming a physician-scientist and gaining research experience, such as combined MD/MS degrees, research residencies, NIH fellowships and the research provided during specialty fellowship training. Do these routes provide sufficient research experience? And are they advisable, considering (for some options) the length may be the same are pursuing the MD/PhD program, but now with medical school debt?

4. Where do physician-scientists work? The two options I almost exclusively hear are either the academic route at a university or the industrial route at a pharmaceutical company. Is private practice an option? And if one were employed by a university, would you have an opportunity to see patients, or are your hours dictated by the university?

As you can see, I really desire to have a 50/50 split between research and clinical, but I'm not quite sure this is likely, or even possible. I do have a strong interest in translational research, and am currently working on a biochemistry project right now which I am passionate about and which relates directly to medicine. However, if I had to choose one or the other, I would lean slightly towards clinical.

Any advice anyone could give would be VERY much appreciated!

1) No, it doesn't have to be that sort of a split. Most of us are focused on a career in research, though, so we tend to drift into research/faculty positions. Others of us decide not to do very much research after graduating. If you wish to stay NIH funded and get competitive (R01) grants, you will be competing against PhD who spend 100% of their time on research, so many of us opting for research mainly focus our energies on such.

2) MDs tend to focus more on clinical research than basic science research. However, some MDs focus most of their time on research and delve into more basic science areas. The downside is that it can be hard to enter academia out of a medical setting without a PhD. Also, MDs need to do research on their own time (take time off from medical school, do a post-doc after residency, do research during medical school...), which can be frustrating sometimes.

3) That works as well. However, with debt, a career in academia may not be attainable, and one may have to enter private practice. Those of us who want to go into academia for sure usually try to do an MD/PhD program so that this is still an option when we finish.

4) Graduates of my program usually go into an academic position. However, 10% or so go into industry, and 10-20% go into private practice. I think this is fairly representative. Some people end up with a lot of debt or end up getting married and having kids, forgoing a postdoc or research position after residency. I know of a few who have gone to work for international organizations (WHO...) or work at the NIH/government/CDC/DoD... It depends on your interests and career goals.

 

[evo]

Hello everyone!

I am a pre-medical student considering pursuing an MD/PhD degree. My original goal was to become an MD and specialize in Immunology, but after being exposed to research, I find that this something I both enjoy doing and hope would enhance my career as a clinician. However, after learning more about the physician-science training program and the careers for physician-scientists, I have several questions:

1. I have read that most MD-PhDs spend most of their time doing research. Is this because research is essentially an "all or nothing" endeavor? That is, if I wanted to do research at all, would it require me to adhere to the common 80/20 research/clinical ratio that I hear is very common?

2. I am aware a person with "just" an MD degree can do research. Do MDs that pursue research follow as similar path as MD/PhDs? Is their research/clinical time split any different?

3. I have heard of several alternative paths to becoming a physician-scientist and gaining research experience, such as combined MD/MS degrees, research residencies, NIH fellowships and the research provided during specialty fellowship training. Do these routes provide sufficient research experience? And are they advisable, considering (for some options) the length may be the same are pursuing the MD/PhD program, but now with medical school debt?

4. Where do physician-scientists work? The two options I almost exclusively hear are either the academic route at a university or the industrial route at a pharmaceutical company. Is private practice an option? And if one were employed by a university, would you have an opportunity to see patients, or are your hours dictated by the university?

As you can see, I really desire to have a 50/50 split between research and clinical, but I'm not quite sure this is likely, or even possible. I do have a strong interest in translational research, and am currently working on a biochemistry project right now which I am passionate about and which relates directly to medicine. However, if I had to choose one or the other, I would lean slightly towards clinical.

Any advice anyone could give would be VERY much appreciated!

Here is my take on it, take it with a grain of salt.

1) A lot of people would argue that, but I think it ends up depending on the type of research you do. For any exploratory work, the time that you'll have to invest is immense, thus it's very hard to achieve a balance between clinical and research work. But if your research is more like really small projects that can immediately benefit patient care, then I'd say even a 60/40 or 70/30 clinical/research ratio can be achieved.

2) Lots of MDs do amazing research, but as the name suggested, their research often don't involve much benchside work, if at all. A lot of them seem to go into clinical trials, and half of their time in-patient doing regular clinical stuff and half of their time out-patient doing clinical trials.

3) Can't answer this one for you. But I'm sure there are a lot of different pathways to the same destination. Choose a program that's well designed and structured so that you don't have to run into potential problems with the program itself.

4) Again, I think it totally depends on the institution, but technically you can do anything with your degrees. There is a lot of flexibility.

For me personally, I'm looking for a 60/40 split clinical/research and from the interviewers / directors I've talked to in my interviews, it is totally doable, although a really big commitment. So as long as you know what you are going into and have a strong passion about both patient care and research, there is nothing that can stop you.

 

[gbwillner]

For me personally, I'm looking for a 60/40 split clinical/research and from the interviewers / directors I've talked to in my interviews, it is totally doable, although a really big commitment. So as long as you know what you are going into and have a strong passion about both patient care and research, there is nothing that can stop you.

Ahhhh.... The young and the idealistic.... It's so refreshing to see these days.

 

[evo]

Ahhhh.... The young and the idealistic.... It's so refreshing to see these days.

Haha. I know it's a lot harder to do than it's to say. We'll see, I'll try my best to stay this way.

 

[Neuronix]

1. I have read that most MD-PhDs spend most of their time doing research. Is this because research is essentially an "all or nothing" endeavor? That is, if I wanted to do research at all, would it require me to adhere to the common 80/20 research/clinical ratio that I hear is very common?

More like on the order of half of MD/PhDs spend most of their time doing research. This is however more a reflection of how difficult it is to establish a research career than it is on the goals of MD/PhD programs. Basic/bench research is almost an all or nothing endeavor or roughly 80% research/20% clinical. Well, or the reality, 80% research/80% clinical. Clinical research is not this way and the amount of research time devoted to it varies. However, MD/PhD programs are mostly designed to produce basic researchers, and they will expect you to want that.

2. I am aware a person with "just" an MD degree can do research. Do MDs that pursue research follow as similar path as MD/PhDs? Is their research/clinical time split any different?

They have to get the research experience somewhere. For some this is extensive research experience that did not confer a PhD degree. This research can be picked up during medical school (one year + summers), then in fellowship (several years). The final research/clinical split is determined by what you're doing, again bench vs. clinical research. It doesn't have much if anything to do with how you're trained.

3. I have heard of several alternative paths to becoming a physician-scientist and gaining research experience, such as combined MD/MS degrees, research residencies, NIH fellowships and the research provided during specialty fellowship training. Do these routes provide sufficient research experience? And are they advisable, considering (for some options) the length may be the same are pursuing the MD/PhD program, but now with medical school debt?

Ask a different person, get a different answer. When it comes down to it I think one can make 2 arguments for why MD/PhD vs. MD with other research training.

1) Dedicated dual degree training from the outset. Programs that have you thinking like a scientist when a clinician and a clinician when a scientist. That's sort of unrealistic/rosy picture, but it sounds good in interviews.

2) Money. Researchers get paid a lot less and train a lot longer. So it's good to be debt free. There are loan repayment programs (LRP) from the NIH, but the amount they will pay is limited and the funding mechanism is competitive. Nobody knows if it will still exist or on what terms down the line. Currently if you read the literature, it is mostly meant to fund clinical researchers anyway.

4. Where do physician-scientists work? The two options I almost exclusively hear are either the academic route at a university or the industrial route at a pharmaceutical company. Is private practice an option? And if one were employed by a university, would you have an opportunity to see patients, or are your hours dictated by the university?

About 80% end up in academics. But the term academics is misleading. Academics can be anything from 100% clinical to 100% research. About 10% end up in pharma. About 10% end up in private practice. Private practice is always an option but you're essentially giving up research.

As for employed by a university, that's a VERY complicated issue you shouldn't worry about now. You essentially negotiate a contract with how much clinical and research time you have, but it's based on a lot of different factors you shouldn't worry about now.

As you can see, I really desire to have a 50/50 split between research and clinical, but I'm not quite sure this is likely, or even possible. I do have a strong interest in translational research, and am currently working on a biochemistry project right now which I am passionate about and which relates directly to medicine. However, if I had to choose one or the other, I would lean slightly towards clinical.

Based on everything I said, I would steer you towards a 5 year program (free tuition at least!) or a medical school with a research component. Any medical school will let you take a year out (or more) for research, but only the established 5 year programs will give you free tuition to do it.

Again, MD/PhD programs are designed to produce majority basic researchers. You are not really committed to that majority basic research career, and thus should not commit to that long pathway at this time.

 

[evo]

Again, MD/PhD programs are designed to produce majority basic researchers. You are not really committed to that majority basic research career, and thus should not commit to that long pathway at this time.

I respectfully disagree. I feel for as a MD/PhD, you are not limited to basic research only. As long as you are committed to do research (translational or not) that requires a PhD, I feel it's worth the pursuing.

 

[NoSleepNoProblm]

Thanks for the replies Neuronix, Evo and Lil Mick! Lots of great advice. Really appreciate it.

I'd like to add another question to the thread in light of some new things I've learned.

5. How often do physician-scientists participate in translational reserach and how applicable is this to their clinical duties? That is, is it likely that the research a doctor does in the lab can be used to directly to treat his or her patients, or is it more of testing new treatments or ideas that could possibly be used in the future? I ask this because I want to pursue an MD-PhD, but only if my research will benefit my patients (I have a current project in metal toxicity that I would like to continue researching past undergrad).

 

[evo]

Thanks for the replies Neuronix, Evo and Lil Mick! Lots of great advice. Really appreciate it.

I'd like to add another question to the thread in light of some new things I've learned.

5. How often do physician-scientists participate in translational reserach and how applicable is this to their clinical duties? That is, is it likely that the research a doctor does in the lab can be used to directly to treat his or her patients, or is it more of testing new treatments or ideas that could possibly be used in the future? I ask this because I want to pursue an MD-PhD, but only if my research will benefit my patients (I have a current project in metal toxicity that I would like to continue researching past undergrad).

One of the MD/PhDs I talked to whose clinical interest focuses on otolaryngology, and for research, he is working to develop a new imaging devices that allow one to take a relatively high resolution photo of the inner ear. This, according to him, serves a great diagnostic tool for potential diseases in the ear, especially when they are trying to make it a portable device.

Edit: Choose your project wisely, whether your project can benefit patients directly in short amount of time or whether it's some long term exploratory project is completely up to you. The PhD years I feel, will teach you what you need to know to choose a good project for your future lab.

 

[StIGMA]

I respectfully disagree. I feel for as a MD/PhD, you are not limited to basic research only. As long as you are committed to do research (translational or not) that requires a PhD, I feel it's worth the pursuing.

This is not something debatable. MD/PhD programs are designed to develop primarily basic science researchers. Can you do clinical research? Of course. What is research that requires a PhD? Well none, but PhD training as it currently exists produces basic science researchers as the majority of graduates, and the programs are funded in order to initiate people down a career path and not veer off of it.

Maybe you did not understand Neuronix, but he described that many graduates are doing what you describe, being careers in translational research that are not primarily basic science-centric. Nevertheless, the fact the the programs are designed to train basic science researchers is beyond debate.

 

[StIGMA]

5. How often do physician-scientists participate in translational reserach and how applicable is this to their clinical duties? That is, is it likely that the research a doctor does in the lab can be used to directly to treat his or her patients, or is it more of testing new treatments or ideas that could possibly be used in the future?

Any research that you are conducting will be used in the future. I consider tomorrow the future. It is idealized to discover a disease, say an undiscovered protein splice pattern leading to a novel phenotype, or a problem affecting heavy metal deposition in pituitary tissue, and be able to use that information to influence the clinical course of a patient's disease. Typically you will not test new treatments but rather research mechanisms of disease in order to identify targets for treatments.

Most clinical research takes on the order of 5-15 years from discovery to clinical significance. Around 1 in ~10,000 or so drugs make it to FDA-approved market status. You would not be involved in much of this process. Chances are that any discovery you make would have to be used by others (and many many others) in order to ever have a clinical significance.

You would need to be super-specialized such that you are able to see a fair number of patients that are affected by the topic that you are funded to research. The more common diseases have hordes of people already working on them. The rarer diseases are where you may have more impact, but then drug companies and funding are harder to come by in order to develop treatments. At any rate, you will be working for potential interventions into the future, and the chance of impact that you have in initiating novel treatments is minimal.

 

[evo]

This is not something debatable. MD/PhD programs are designed to develop primarily basic science researchers. Can you do clinical research? Of course. What is research that requires a PhD? Well none, but PhD training as it currently exists produces basic science researchers as the majority of graduates, and the programs are funded in order to initiate people down a career path and not veer off of it.

Maybe you did not understand Neuronix, but he described that many graduates are doing what you describe, being careers in translational research that are not primarily basic science-centric. Nevertheless, the fact the the programs are designed to train basic science researchers is beyond debate.

Maybe you misunderstood my point. I'm not debating the design of MD/PhD program or the nature of PhD training. Of course, the majority get a PhD in basic science, but that doesn't mean that you can't convert that into something more translational later in your career. I'm saying, that if OP, is passionate and dedicated about doing research (start from the basics, then gradually work your way to into the translational field) and integrate that with clinical work, then I don't see why MD/PhD is not an option. The only part I'm disagreeing with Neuronix, maybe I misunderstood him, is in the last part. He seemed to suggest that op is not committed enough to basic science, which I cannot judge based on the information available to me.

 

[StIGMA]

Maybe you misunderstood my point. I'm not debating the design of MD/PhD program or the nature of PhD training. Of course, the majority get a PhD in basic science, but that doesn't mean that you can't convert that into something more translational later in your career. I'm saying, that if OP, is passionate and dedicated about doing research (start from the basics, then gradually work your way to into the translational field) and integrate that with clinical work, then I don't see why MD/PhD is not an option. The only part I'm disagreeing with Neuronix, maybe I misunderstood him, is in the last part. He seemed to suggest that op is not committed enough to basic science, which I cannot judge based on the information available to me.

It is a good point, and frankly I agree with you. If you are interested in research now (but not enough to commit your entire career to it), who is to say that during the course of the MD/PhD program that you would not then decide to commit yourself? That is certainly better than falling out of grace with research. The problem is that the programs want you to commit to something that is over a decade into the future and is incompletely understood by applicants and those who are not yet at that clinical/research stage. My point was that the programs are funded for the purpose of furthering the scientific enterprise (although students certainly can decide their own careers).

Neuronix has good point in that it may be wasted time to devote extra years to research training when that training would not be used in the future. Students who are not committed as applicants to a 70/30 or 80/20+ research career at many MD/PhD programs are not considered for admission. A 4+1 program has the advantage of finishing years sooner (average 3) with the option of pursuing more research in the future (for example, that may be it further basic science training as a fellow to become a PI, it may mean taking a clinical professor job and doing clinical/ translational research with no further training, or no research at all).

 

[Neuronix]

Stigma said everything I would have said. I will just summarize.

1) You can do whatever you want with your MD/PhD degree.

2) As an applicant you're expected to express your love for basic science in addition to medicine, which involves in the minds of most program directors a majority research career.

3) If you do not see yourself in a majority research career, the PhD is not as valuable to your future. You also are more likely to leave the MD/PhD program when you run into difficulties during your PhD.

 

[Guero]

Great conversation everyone! I love that the MSTP threads seem to have better written responses than many of the other topics.

Does anyone have a take on the research/clinical ratio of MD/PhD surgeons, especially neurosurgeons? I've heard from many attendings, including my NS mentor, that it's most often the reciprocal of medicine: 80% clinical and 20% research. Yet, along with prior posts, I can't imagine successfully running your own lab with a 20% devotion to research. Granted, my mentor transitioned to clinical research; so maybe I just haven't had the chance to meet or find an MD/PhD neurosurgeon with an 80% research and 20% clinical ratio...

Any thoughts?

 

[solitude]

Great conversation everyone! I love that the MSTP threads seem to have better written responses than many of the other topics.

Does anyone have a take on the research/clinical ratio of MD/PhD surgeons, especially neurosurgeons? I've heard from many attendings, including my NS mentor, that it's most often the reciprocal of medicine: 80% clinical and 20% research. Yet, along with prior posts, I can't imagine successfully running your own lab with a 20% devotion to research. Granted, my mentor transitioned to clinical research; so maybe I just haven't had the chance to meet or find an MD/PhD neurosurgeon with an 80% research and 20% clinical ratio...

Any thoughts?

If you are 80-20 clinical-science, you will not have a lab, or at least practically speaking you will be doing virtually nothing but appending your name to grants. This is particularly true because neurosurgeons work very long clinical hours, so it's virtually impossible to fit in science around the clinical stuff. However, academic neurosurgeons are usually 80-20 clinical-science, where science = clinical research, or collaboration with basic scientists. This is a great path to take, and is highly amenable to MD-PhDs (just don't tell this to the adcom when you are applying). But if you are going to do basic science research, you will have to do 20-80 clinical-science. There are a few PIs at my school who are neurosurgeons and pull this off, doing top-flight science and, from what I hear, good (but not exceptional) surgeries.

 

[24thGrade]

Nevertheless, the fact the the programs are designed to train basic science researchers is beyond debate.

This is not true. While I would agree that training basic scientists is the agenda of the NIH, there are definitely exceptions out there. I know that my MSTP as well as other institutions offer PhDs in clinical research as part of the MSTP. Don't get me wrong, the people that take these routes are definitely the minority but it doesn't mean that there aren't programs out there that will train you to do mainly clinical research as part of you MD-PhD. It is certainly debatable whrether or not a PhD is overkill for a career in clinical research but the generally awful (and I'm being generous here) quality of clinical studies might suggest it isn't.

 

[StIGMA]

This is not true. While I would agree that training basic scientists is the agenda of the NIH, there are definitely exceptions out there. I know that my MSTP as well as other institutions offer PhDs in clinical research as part of the MSTP. Don't get me wrong, the people that take these routes are definitely the minority but it doesn't mean that there aren't programs out there that will train you to do mainly clinical research as part of you MD-PhD. It is certainly debatable whrether or not a PhD is overkill for a career in clinical research but the generally awful (and I'm being generous here) quality of clinical studies might suggest it isn't.

The MSTP is the term applied to the NIGMS-funded programs. The NIGMS originally designed the MSTP for the expressed purpose of increasing basic science research in medicine, ie: bridge the gap between basic science and clinical medicine. That there are programs that 'will train you to do mainly clinical research' is not relevant to my point. Of course you can do an MD-PhD program and not focus on basic sciences.

I never disputed that MSTP's do not offer research outside of basic science routes. I am not going to pursue this any further with you.